A 60yo smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers. Exam: cold extremities with lack of hair around the ankles, absent distal pulses. What is the
most probable dx?
a. Intermittent claudication
b. Chronic ischemia of the limbs
c. Buerger’s disease
d. DVT
e. DM
answer: B
Clinical Features
• claudication
1. pain with exertion: usually in calves or any exercising muscle group
2. relieved by short rest: 2-5 min, and no postural changes necessary
3. reproducible: same distance to elicit pain, same location of pain, same amount of rest to
relieve pain
• critical limb ischemia (CLI)
1. includes rest pain, night pain, tissue loss (ulceration or gangrene)
2. pain most commonly over the forefoot, waking person from sleep, and often relieved by
hanging foot off bed
3. ankle pressure <40 mmHg, toe pressure <30 mmHg, ABI <0.40
• pulses may be absent at some locations, bruits may be present
• signs of poor perfusion: hair loss, hypertrophic nails, atrophic muscle, skin ulcerations and
infections, slow capillary refill, prolonged pallor with elevation and rubor on dependency,
venous troughing (collapse of superficial veins of foot)
• other manifestations of atherosclerosis: CVD, CAD, impotence, splanchnic ischemia
When oxygenated blood in your body is not sustained, it can cause pain in your calf. To overcome this pain you can use calf compression sleeve which will provide ultimate support to your muscles and will improve muscle efficiency.
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